contents message from the president - csam-smca...cme opportunities & corporate sponsors .....24...

The CSAM SMCA Bulletin is published by the Canadian Society of Addiction Medicine. It is a journal for the dissemination of knowledge & clinical experience related to addiction medicine. If you are a CSAM SMCA member and would like to contribute

an article, or letter to The Bulletin, please send an email to the editor Dr. Michael Varenbut: [email protected]. Please forward your correspondence to: [email protected]

March 2007 Volume 11, Number 1

CONTENTS

EdiTor iN-CHiEF Dr. Michael Varenbut

ASSoCiATE EdiTor Dr. Frank Evans

Message from the President

An official publication of

CSAM Head OfficeSuite 201, 375 West Fifth AvenueVancouver, BC, Canada V5Y 1J6

Tel: 604.484.3244Fax: 604.874.4378

Email: [email protected]

Message from the President ............ 1

Message from the Editor .................. 2

Conference Committee report ........... 2

Membership Committee report ......3-4

Membership Application ................5-6

Opoid Agonist Committee report ...... 7

News from across Canada ...........8-10

Corrections Canada Corner ............ 11

Recovery Corner ........................12-13

Research Corner ........................14-20

Call for Abstracts ........................21-23Board of Directors, CME opportunities & Corporate sponsors ....................... 24

Dear Colleagues

The new year is already upon us and I am pleased to convey to the membership that CSAM is now functioning at a level of professionalism, intensity and efficiency never before experienced.

The CSAM Board is meeting on an almost monthly basis in order to facilitate the conducting of our business. As such, we are now proceeding forward in many different areas such as new committees, fine-tuning our bylaws and preparing for the fall conference.

I hope you will be pleased with our efforts and results.

Respectfully YoursFrank EvansPresident CSAM

The CSAM SMCA Bulletin

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CSAM Committee Reports

Message from the EditorDear fellow members,

It is with great pleasure that we bring you this issue of the CSAM Bulletin. It encompasses the great contributions of many members of our society, some new to the bulletin, while others are reliable “veteran contributors”.

The overall objectives and aim of the bulletin, is to update our members from across the country on significant changes and developments in our field, be it local provincial news, or global changes. We also hope to be able to update the membership on the work done by various CSAM committees on behalf of our membership, towards improving the overall communication and involvement of our members.

New to this issue you will find a new “Corrections Canada Corner”, which we hope to make a regular addition to the bulletin, with valuable input from our colleagues and members who are involved in a variety of clinical settings within correctional facilities across the country.

We hope that you find this issue both interesting and informative, and as always, we hope that you chose to contribute to the Bulletin, and share with us your expertise, clinical experiences, research and anything else that you feel would be worth while for the membership to know.

Respectfully yours,Michael VarenbutEditor in Chief

CSAM 2007 Organizing Committee ReportBy Dr. Jeff DaiterChair, CSAM 2007 Organizing Committee

The work of the Organizing Committee for this year’s Scientific Conference, slated for October 11 – 13, 2007 in Ottawa, is in full swing with meetings of the Committee occurring at a frequency of every two weeks.

Committee members represent a varied background in the field of Addiction Medicine thereby lending credibility to properly addressing the theme of this years meeting which is “Multiple Disciplines, Shared Cause: Connecting Professionals in Addiction Medicine”.

Enthusiasm amongst Committee members for this project remains high and it promises to be the most successful meeting to date. Focus is being placed on attracting a wide variety of allied health professionals with an interest in the Addiction field.

Take the time to speak to colleagues and encourage those with an interest to attend this year’s conference. They will not be disappointed.


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Membership Committee Report By Michael Varenbut MD

CSAM has 220 members renewed for 2007, of which there are 126 MD Members, 5 PhD Members, 10 Honourary Members, 72 Associate Members, 5 Retired Members, and 3 Student Members.

It is with great pleasure that we welcome the following new members to CSAM:

FULL NAME MEMBEr STATUS PriMArY PriMArY CiTY ProViNCE

Carey Vigor MD St. Clair Shores MI, USA

Jeffrey Buttle MD Vancouver BC

Paul Mulzer MD Thunder Bay ON

Nancy Cherry Associate Cambridge ON

Antonietta Chiappetta Associate Toronto ON

Kathleen Demitre Associate Lindsay ON

Jon Hall Associate Cornwall ON

Bonnie Heipel Associate Cambridge ON

Jennifer Heipel Associate Guelph ON

Linda Labelle Associate Longlac ON

Natalie Laderoute Associate Longlac ON

Eleanor Neary Associate Newmarket ON

Trina Regan Associate Longlac ON

Carolyn McAnally Associate Cambridge ON

Kim Renaud Associate Dryden ON

Yvette Roy Associate Lindsay ON

Sridhar Nilam MD St. Catharines ON

Diane Kunyk Associate Edmonton AB

Carolyn Plater-Zyberk Associate Richmond Hill ON

Colleen Stephenson Associate Lindsay ON

Stacey Hare Hodgins Associate Thunder Bay ON

Paul Sutton Associate Thunder Bay ON

Meredith Collyer Associate Barrie ON

Matthew Leroux Associate Sudbury ON


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New to the membership committee, is the issuance of membership certificates, to all current and new members, which we can all display with pride. Each member will be receiving a membership certificate in printed format, and also in electronic (pdf) format to use as they wish. Please find attached a sample membership certificate.

As always, we are more than happy to accept new members to our society, and look forward to the assistance of current members in recruitment. Please find attached a membership application form for your use. This is also available on line at the CSAM web site, at www.csam.org.

Certificate of Membershipin the Canadian Society of Addiction Medicine

CSAM Member Since: Frank Evans, CSAM President

Dr. CSAM Member

continued from page 3


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Please forward your application form with cheque or credit card information to:CSAM Head Office 375 West 5th Avenue, Suite 201 · Vancouver, BC, V5Y 1J6 ·

Phone 604-484-3244 · Fax 604-874-4378 · Email: [email protected]

2007 Membership Application Form

Membership Type

Regular Member – MD Regular Member – PhD Scientists Medical Student/Intern/Resident Retirees – MD or PhD Associate Member

Applicant Information Dr. Ms. Mrs. Miss Mr.

Name:(First Name) (Middle Initial) (Last Name)

Work Address Preferred Mailing AddressAddress:

City: ____________________________ Province: ____________ Postal Code:____________________

Work Phone: _________________________________________ Fax: ___________________________________

Home Address Preferred Mailing Address

Address: _________________________________________________________________________________

City: ____________________________ Province: ____________ Postal Code:____________________

Home Phone: ______________________________________________________

Email Contacts*

Email address: ___________________________________________________________________________________

Education History

Undergraduate Degree(s)/University/Year Graduated:

Graduate Degree(s)/University/Year Graduated:

Area of Specialty:

Current Employment:

Area of Employment: Private Practice Treatment Centre Educational Facility

Other (please specify) :

Appointment(s) – Hospital/University/College Including Department: ________________________________________

Percentage of time in research and clinical practice devoted to: Percentage of time devoted to:Addiction: % Clinical Practice: %Other aspects of healthcare: % Research: %Total: 100% Teaching: %

Administration: %Other: %Total: 100 %


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Opioid Agonist Committee Report

Please forward your application form with cheque or credit card information to:CSAM Head Office 375 West 5th Avenue, Suite 201 · Vancouver, BC, V5Y 1J6 ·

Phone 604-484-3244 · Fax 604-874-4378 · Email: [email protected]

Addiction Medicine AffiliationsAmerican Society of Addiction Medicine (ASAM): Member

Certificant Year of Certification/recertification: Fellow Year of Fellowship:

International Society of Addiction Medicine (ISAM): Member Certificant Year of Certification/recertification:

Are you interested in Canadian Certification in Addiction Medicine? (Member – MD only) Yes No

Topics of Special Interest in the Field of Medicine

Positions in the Society You Would Be Willing To Consider in the Future

Board Member (Please note: Associate members are not eligible for board positions)

Committee Membership: Standards Public Policy Research Education Physician Health

Referee and Curriculum VitaePlease include a recent copy of your Curriculum Vitae.All new members require a current CSAM member to act as a referee. A supporting letter from a current CSAM membermust accompany all applications for Associate membership.

Referee’s Name:

Do you agree to have your name and office contact information included in a directory to be distributed to CSAM membersonly? Yes No

Signature:

Payment Information

Annual Fees: Regular Member – M.D.: $100.00 Medical Student/Intern/Resident: $25.00 Regular Member – PhD Scientists: $100.00 Retirees MD or PhD: $25.00 Associate Member: $50.00

Optional: International Society of Addiction Medicine (ISAM) Dues – (US $90.00 @1.17761, effective Nov 1 2006)NOTE: ISAM Membership not available to Associate Members ISAM Membership: $105.99

*TOTAL PAYMENT: $ .

Cheque, Bank Draft or Money Order Payable to: The Canadian Society of Addiction Medicine or

VISA/MC/AMEX (circle one) # Expiry Date _________

Name on Card: Signature:


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By Michael Varenbut MD, CCSAM, CASAM, FASAMChair

It is my pleasure to inform you that at the last CSAM board meeting, the “Terms of Reference” for the Opioid Agonist Committee were accepted unanimously by the board.

The committee members are busy working on a variety of items discussed in the Terms of Reference, and will be reporting to the board and membership on a regular basis.

Please find below the Terms of Reference for the committee:

Preamble:The Opioid Agonist committee has been convened on behalf of the CSAM board and membership to address issues of concern to the society and its membership with respect to opioid agonist therapy.

Purpose:The purpose of the committee is to advocate the ongoing development of “Best Practices” in Opioid Agonist Therapy (OAT) and to advocate and support training for and delivery of such programs.

This will be accomplished through:• Establishing minimum criteria for training and education for physicians in Opioid Agonist Therapy. This would not include the delivery of such training.• Evaluating and reviewing, as requested, training for physicians in OAT, to ensure they meet set minimum criteria.• Producing a Public Policy Statement re OAT, and ensuring said statement remains current.• Engaging in two way communication with CSAM board and membership to ensure all involved are aware of changing issues in the field of OAT.

Membership:The committee will consist of a chair and a maximum of 6 members.Chair and members must be CSAM members.Terms of membership are subject to periodic review and Board approval.

Frequency of Meetings:The committee will meet quarterly; 3 teleconference meetings and 1 “in person” to coincide with the annual CSAM Scientific Meeting. Members are asked to commit to participate in a minimum of 50% of the teleconferences and to attend the “in person” meeting.

Decision Making Process:Consensus. In the exceptional circumstance where consensus is unachievable, decisions will be decided by majority vote (50% + 1)

Reporting Process:Committee will report on its activity regularly at board meetings and at the CSAM annual general meeting.

Committee Members:Brian Fern, Suzanne Brissette, Kathryn MacCullam, Kumar Gupta, Wade Hillier, John Fraser and Michael Varenbut

Opioid Agonist Committee Report


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“News from across Canada”Alberta NewsCharl Els MD, & Diane Kunyk

1. The Edmonton Police Commission deserves our praise for announcing that they are looking into “damp” shelters to try and remedy the current situation where none such facilities exist in the Province. A recent study published in the CMAJ provided evidence of optimistic outcomes such services may have in people with a combination of severe social and addiction-related problems. Such harm reduction approaches have demonstrated improvements in saving lives, saving healthcare dollars, cutting conflicts with police, and the reduction of ER visits. The current absence of “damp” or “wet” shelters in Alberta and Edmonton is merely a perpetuation of the status quo; whereby the existing system has left Albertans with the second-highest addiction rates in Canada, and unchanged smoking rates that continue to be well above the national average. However, the innovative approach by the Police Commission is merely one small remedy to a much larger problem and reminds us that we need a major philosophical overhaul in terms of how we treat addictions (in most jurisdictions) in Alberta. The deputy Police Commissioner, Mr. Murray Billet and his team deserve kudos for suggesting an upstream option for one symptom of the addiction systems’ failure.

2. The Alberta Alcohol and Drug Abuse Commission have made several changes in their structure. After the departure of a senior member due to misappropriation of funding, there was another high-level departure. The tobacco research arm was phased out and any tobacco research is now allegedly integrated into the general research stream within AADAC. No reasons were provided to the public on the reasons for the sudden and major changes. Mr. Harvey Cenaiko, Alberta’s previous Solicitor General (and allegedly a smoker) was appointed as the Chair of the Alberta Alcohol and Drug Abuse Commission, and has indicated in a vision statement that he wishes to focus on the Crystal Meth epidemic in the Province. There were comments that a smoking ban in public places was not high on his list of priorities, and it is noteworthy that Alberta

remains one of the few provinces without such protection for all workers.

3. Further on the tobacco front: The newly elected premier, Hon. Stelmach, has indicated a readiness to move towards more comprehensive tobacco reform in the Province. The Coalition for a Smoke-Free Alberta is lobbying for adequate Smoke-Free places legislation, the banning of tobacco sales from Pharmacies (currently Alberta is one of four provinces where tobacco is sold in pharmacies), a tobacco tax increase, and the banning of power-walls of tobacco. Alberta will also not participate in the current national wave of legal action against tobacco industry to recover the losses sustained over the course of years.

4. Albertans remain exposed to one of the tobacco industry’s most influential marketing strategies: Power walls in pharmacies. In an attempt to abolish this most incongruous form of tobacco marketing, a complaint was filed by Physicians for a Smoke-Free Canada against all pharmacies that sell tobacco. The differing interpretation of a critical ethical issue among Canadian provinces remains perplexing, and there is no reason why the Quebec ruling (and the ethical stance in the seven other provinces and territories) should not also apply to the remaining provinces with pharmacy tobacco sales, including Alberta. Two large-scale surveys among pharmacists have demonstrated overwhelming support for banning tobacco sales in Alberta’s pharmacies. However, the complaint was rejected by the local regulatory body. It was followed by a second, similar complaint naming five specific pharmacies selling tobacco, but after more than a year of waiting, the complainants were recently notified that it is “wrong” to use this avenue to forward a policy agenda.


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5. Smoke-free policies (or movement towards such conditions) in psychiatric facilities appear to become the norm in several regions, and many facilities are adopting strict guidelines in this regard. 6. Edmonton will be the host city for the Canadian Council on Tobacco Control’s 5th Tobacco or Health Conference in October 2007, and abstracts are now accepted.

7. The Methadone maintenance program continues to move forwards in its quality improvement process, and peer-review protocols are being put in place.

8. The Physician Health Monitoring Program of the College of Physicians and Surgeons is currently advertising for the Services of a MRO.

9. On macro-level, Alberta remains one of the very few provinces where the addiction system has not been adequately integrated into healthcare, and where it remains artificially separated. Several other provinces without this disconnect have long surpassed (most Albertan jurisdictions) by actualizing cutting edge advances in


Ontario NewsBy Jeff Daiter MD, CCFP, FCFP, DABSM, CASAM, CCSAM, FASAM, MRO

Members from Ontario continue to wait patiently for the report expected from the Methadone Task Force, a working group

appointed by the Ministry of Health to provide advice to government on the best approaches for the provision of methadone maintenance treatment in Ontario. In preparation for this, the Task Force recently completed it visits to several communities across Ontario in order to seek input from various stakeholders. On it’s website (www.methadonetaskforce.com) , the Task Force has acknowledged that Methadone maintenance treatment (MMT) is still the clinical standard and the most widely used form of treatment for people who are dependent on opioids. The report, which was anticipated to be completed by March 31, 2007 has been delayed and remains in its draft form at the time of this printing. Nevertheless, it is hoped that it will reach the Minister of Health’s office in the next few weeks and he will endeavor to deal with it in a timely fashion.

PEI News By Dr. Don Ling MD and Barbara Lacey MSW RSW

The PEI Provincial Methadone Maintenance Treatment Program has a current active caseload of 51, with a waiting list of approximately 60

individuals.

The program began modestly in 2004 under the auspices of the Dept of Health. It is located at the Provincial Addiction Treatment Facility (PATF) in Mt Herbert, a site combining 24 inpatient detox beds, outpatient detox and a 12 bed inpatient rehab program.

There are 2 physicians covering the daily work at PATF, although the provincial Addictionologist is currently on extended sick leave.

This leaves an immediate opportunity in PEI for a physician to work full time in Addiction Medicine, preferably one with an interest in opioid agonist therapy. The PEI MMT program uses inpatient induction for methadone committing 1 of the detox beds to this purpose. Upon discharge clients must travel at most 2 hours, for their physician appointments at PATF. PEI does have four other out patient Addiction Services offices across the province where clients are followed closer to home for random urine collection and supportive counselling.

Other important recent developments include an emergency Annual General Meeting called by a concerned quorum of members belonging to the Ontario Medical Association Section on Addiction Medicine. At that meeting on April 12, 2007, new section executive were voted in consisting of Dr. Rob Cooper as Chair, Dr. Sharon Cirone as Vice Chair, Dr. Michael Lester as Secretary and Drs. Jeff Daiter and Alan Konyer as Members at Large. The new executive are planning to work hard at improving communication between the Section Executive and the members, and building positive bridges between the Section and the OMA in an effort to raise the profile of Addiction Medicine within the Ontario Medical Association and the province as a whole.

Many thanks for the hard work of the outgoing Executive, Chaired by Dr. Frank Evans, Vice Chair Dr. Michael Bludoff and Secretary Dr. Stephen Melemis


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continued from page 9Currently the clients are expected to attend a 10 week MMT support group at PATF. Initially physician appointments and group times are coordinated to limit transportation costs and time. One of the future plans for the program is to provide a MMT clinic in PEI’s other major centre,

Summerside, as well as MMT support groups in both east and west sites. The program is anticipating increased resources from government for the 2007/08 fiscal year.

Current stats show a breakdown of clients as being 1/3 female and 2/3 male.

Of the 51 clients 7 have been in treatment for 2+yrs, 27 between 1 and 2 yrs and 17 are in year one. There are currently 25 clients abstinent of all substance use. Cocaine is the primary relapse drug. There are 6 clients who continue to use cannabis and are restricted from carries. Of the 51; 16 have returned to work; 22 have increased access and parenting involvement with children and 2 have returned to a study program.

Over the past 2.5 years a team of 2 physicians, 4 nurses, 8 counsellors, 1 admin support (all part time) and a tireless Social Worker, as full time coordinator, have come together to more strongly embrace the harm reduction philosophy in Canada’s smallest, and some might say, most conservative province. The future holds promise.

Quebec NewsBy Dr. Suzanne Brissette

Le traitement de substititon à la Méthadone n’est pas encore disponible facilement au Québec, et ce malgré les efforts consentis en 1999 par le

gouvernement provincial. Le problème vient surtout du nombre restreint de médecins détenant leur permis de prescription de méthadone. Il est donc important que les médecins de l’extérieur du Québec comprennent la situation et réalisent qu’il peut être très difficile pour leurs patients de se trouver un médecin prescripteur en cas de voyage ou déménagement.

En ce sens, il est important de savoir que la prescription de méthadone d’un médecin pratiquant dans une autre province sera honorée dans la plupart des pharmacies de la province, tant et aussi longtemps que le médecin prescripteur le désire. Même si ceci ne constitue pas une

situation idéale, cette solution est sans doute préférable à une interruption abrupte du traitement. En cas de problèmes le SAM peut offrir de l’aide.

Sur une note plus agréable, le Pavillon André Boudreau, qui dessert la région des Laurentides, est fier d’annoncer la venue d’une nouveau médecin, le Dr Emmanuelle Huchet. Cet ajout devrait permettre l’ouverture d’une vingtaine de places de traitement de substitution à la méthadone

There is still a shortage of methadone prescribers in the province and MMT is still not readily available, despite efforts to increase places in MMT by the provincial government in 1999. It is important that physicians of other provinces are aware that it is often difficult for their patients to find a methadone prescriber when they are travelling or moving to the province.

In that respect, physicians should be informed that most Quebec community pharmacies that serve methadone will honour the prescription of a physician from another province, for a length of time that depends mostly on the physician‘s comfort in prescribing for long periods of time. Although that might be considered as suboptimal treatment, it might be preferable that an abrupt interruption in treatment. In cases where there is a problem, for example, the pharmacist not willing to dispense the methadone, the SAM (Services d’Appui à la Méthadone ) can offer some assistance.

On a more pleasant note, the Pavillon André Boudeau, which serves the Laurentians region, is glad to announce the arrival of a new physician, Dr Emmanuelle Huchet, which should open approximately 20 new MMT places.

Coordonnées du SAM / The SAM co-ordinates are:110 Prince Arthur ouestMontréal, QCH2X 1S7Telephone: 514-284-3426 or 1-866-726-2343Télécopieur/fax: [email protected]


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The Correctional Service of Canada (CSC) as part of the criminal justice system and respecting the rule of law, contributes to public safety by actively encouraging and assisting offenders to become law-abiding citizens, while exercising reasonable, safe, secure and humane control. Mission Statement, CSC

CSC currently houses almost 13,000 inmates in its 58 institutions. Most offenders, upon entry to CSC, are assessed for alcohol and drug addiction issues using the Alcohol Dependency Scale (ADS) and the Drug Abuse Screening Test (DAST). Roughly 26% of inmates have DAST levels of Substantial or Severe and are referred for high intensity substance abuse programming. Offenders who suffer from opioid addiction can apply for Methadone Maintenance Treatment (MMT).

CSC introduced Methadone Maintenance on World AIDS Day (December 1, 1997). During Phase 1, only offenders who were already on methadone at the time of incarceration had access to MMT. After February of 1999, offenders could be started on MMT if there were exceptional circumstances. Phase 2, which allowed for any opioid dependent offender to apply for MMT, came into effect in May of 2002. As of November, 2006, there were 717 federal offenders on MMT nationwide. Since 2004, CSC has provided MMT to over 1000 individual offenders each year.

Any offender can apply for admission to the MMT program. The application is considered by a Multidisciplinary Intervention Team (MIT) consisting of members of Health Services (MD, RN), a substance abuse program delivery officer, and a parole officer.

To be considered for MMT an offender must meet all three of the following criteria:

• Diagnosis of dependence to opiates as established in the DSM-IV or a well documented history of opiate addiction indicating a high risk of relapse, as confirmed by a certified institutional physician;

• A small likelihood of benefit from non-methadone treatment as evidenced by a past history of treatment failures;

• Agreement to terms and conditions of MMT as evidenced by acceptance and willingness to sign the MMT Agreement.

The Multidisciplinary Intervention Team gives priority to applications from:

• Female inmates who are pregnant and currently opioid dependent or were previously opioid dependent and are at a high risk of relapse;

• Inmates who are HIV positive and currently opioid dependent or were previously opioid dependent and are at a high risk of relapse;

• Inmates who have been determined to require treatment for Hepatitis C;

• Inmates who are currently opioid dependent with a recent history of life-threatening overdose and other conditions directly related to their opiate dependence;

• Inmates who are opioid dependent and will be released within 6 months with established community release plans.

The MIT monitors the offender’s progress on MMT while incarcerated and must make provision for continued MMT once the offender has been paroled or released.

The goal of the program is to assist the opioid dependent offender to become stabilized in his/her methadone assisted recovery. This greatly reduces the risk of drug related recidivism and increases the former offender’s chances of successfully reintegrating into society.

“Corrections Canada Corner” Methadone Maintanence in the Correctional Service of Canadaby Dr. Leo O. Lanoie and Joanne Barton RN


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At the core of addiction – is a compulsive tendency to use a drug or to engage in an activity that changes how one feels – to dodge one way of

feeling – and to manufacture another.

The compulsion to use may be active – or it may linger and recur during times of anger, stress or complacency. True addiction has lost connection to the reasons why one began to use in the first place and has taken on a course of its own – beyond rational sense, casual habit or psychological meaning.

Left unchecked, other aspects of life and personhood may be overtaken by the compulsive appetite of addiction. Healthy routine and relationships are left aside. The need to obtain and to use drugs becomes a priority of day to day life. Mental habits of thought, feeling and perception are distorted by the pull to use. Destructive changes may occur within the brain.

Regrettably, the compulsion to use and the distortions of lifestyle, mind and brain that occur – do not disappear just because an addicted person decides one day that they do not wish to use. Education, support, lifestyle change and specific treatment are often required for early abstinence to take hold.

Recovery is about learning to enjoy life without the use of alcohol or drugs that alter mind or mood. It is a day to day remedy for the compulsive tendencies addiction – an approach to the challenges of life – and a path to personal growth. Recovery is not so much about stopping to use drugs in the first place – but more to do with ‘not starting’ to use again today.

Recovery may be personalized – but it has its necessary principles and ways. It is not just about ‘holding on’ to abstinence. It is not always about doing what feels good right now. And because the tendency of addiction persists

over time – active participation in recovery is best sustained on a day to day basis – one day after another.

A Personal Program of Recovery is a reminder list – of those things important to do each day and week in recovery from addiction. Ask for help in the morning – Give thanks at night – Recovery reading – Quiet time for personal inventory – Connecting with others in recovery – Attendance to recovery support group – Medical or counseling appointments – Journal writing and personal inventory.

It is easy to lose track of things kept just in our head. We get busy, distracted – and lose direction. A Personal Program of Recovery is a commitment to health – and is best written down. Writing items down on paper helps to organize, sustain and to track one’s activities of recovery.

A weekly diary, notepad or computer may be used to record a Personal Program. What few things will I do for my recovery each day? What recovery support meetings will I attend to each week? Have I included time for exercise or quiet relaxation? What recovery activities have been most helpful to me? What have others told me has been necessary for them to do? What have I left out – or what am I avoiding?

What things are best for me to set aside just now? Going to a pharmacy alone – Letting myself get too tired – Spending too much time alone – Going to a bar – Treating my own symptoms – Playing resentments in my mind – Working long hours – Being with others who are using – Too much empty time – Taking on too much at once.

There are many triggers to relapsed use. But each of us has one or two people, places or things most likely to get under our skin. These items belong on a Personal Program. Make a list of those triggers most likely to

“Recovery Corner”A Personal Program of RecoveryJohn Craven MD, FRCPC


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challenge your recovery. Remind yourself daily – to be alert to those risks.

Regardless of all efforts – a day will come when you feel overwhelmed or at other risk to your recovery. Make a list of what you will do. Be specific. Write down the names and telephone numbers of the people you would contact – or the places you would go.

A Personal Program is also a foundation – a steady part to one’s day and week. Regardless of what else happens, your program is there to rely upon. It provides a structure and a routine to one’s day – and grounds us in the activities of our recovery.

The program is there to follow when we are feeling lazy. It is there when we are worried – or confident – about our recovery. The program is a reminder of what to do when we have the time – or when we are pressured, stressed or busy. A Personal Program of Recovery counteracts the disarray of addiction – and provides a centering ground of stability for those days when we are complacent, restless, pressured or distracted by other apparent priorities.

Treatment programs emphasize the importance of daily routine, balance and structure in recovery. A Personal Program is self structured aftercare – helping one to sustain the activities of recovery beyond the intensive routine of residential treatment.

SupportNet.ca offers printable Recovery Resources – to help one get started with a Personal Program of Recovery. A Relapse Trigger Inventory – the Coping and Crisis Planner – a One Day in Recovery record – and a sample Journal page. A notes handbook titled ‘Your Personal Program of Recovery’ provides a summary of this writing – and a simple outline for recording a recovery routine.

As in all activities of life – apply the principles of recovery to your Personal Program. Keep it simple and be realistic. Don’t clutter your day with more than you can handle – but do what you need to do. Don’t give up if all does not go right the first time around. Listen to the experience of others. Put first things first – and follow through with what you’ve written down. Don’t change things every day. But don’t also be too rigid. Time is well

spent – to organize and update a program list for each new week.

In Summary

The compulsive tendency of addiction may linger and recur – during times of anger, stress or complacency. Life can be busy and recovery is easily nudged aside.

A Personal Program grounds us in the activities of our recovery. It is a commitment to health – and a reminder of what is necessary to do each day and week.

Recovery counteracts the compulsive tendency towards relapsed use – and provide a foundation for personal growth. Keeping a simple, personalized program can help to sustain the activities of recovery – one day at a time and day after day.

Resources

Your Personal Program of Recovery – part of the Recovery Learning Series at www.SupportNet.ca – freely available in Audio Annotated Slide Shows, Streaming Audio and Podcasts.


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Research CornerBy Dr. David Teplin, Psy.D., C.Psych.

Screening for Alcohol Use Patterns among Methadone Maintenance Patients

Alcohol use among Methadone Maintenance Treatment (MMT) patients poses a major health risk, exacerbates psychopathology, and increases the risk of death by accidental overdose. Despite these factors, screening for alcohol use remains underutilized in the methadone community. Utilizing a self-report screening measure - the Michigan Alcohol Screening Test (MAST) - and consistent with the literature, we found high rates of alcohol problems among MMT patients. Benefits and limitations of using the MAST to screen for alcohol use patterns are discussed.

The American Journal of Drug and Alcohol Abuse, Volume 33, Issue 1 January 2007, pages 179 – 183; David Teplin, Barak Raz, Jeff Daiter, Michael Varenbut, Carolyn Plater-Zyberk

A �-year Evaluation of a Methadone Medical Maintenance Program

Methadone medical maintenance (MMM) is a model for the treatment of opioid dependence in which a monthly supply of methadone is distributed in an office setting, in contrast to more highly regulated settings where daily observed dosing is the norm. We assessed patient characteristics and treatment outcomes of an MMM program initiated in the Bronx, New York, in 1999 by conducting a retrospective chart review. Participant characteristics were compared with those of patients enrolled in affiliated conventional methadone maintenance treatment programs. Patients had diverse ethnicities, occupations, educational backgrounds, and income levels. Urine toxicology testing detected illicit

opiate and cocaine use in 0.8% and 0.4% of aggregate samples, respectively. The retention rate was 98%, which compares favorably with the four other MMM programs that have been reported in the medical literature. This study demonstrates that selected patients from a socioeconomically disadvantaged population remained clinically stable and engaged in treatment in a far less intensive setting than traditional methadone maintenance.

Journal of Substance Abuse Treatment 31 (2006) 433– 438 Kenneth A. Harris, Jr, Julia H. Arnsten, Herman Joseph, Joe Hecht, Ira Marion, Patti Juliana, Marc N. Gourevitch

Behavioral Therapy to Augment Oral Naltrexone for Opioid Dependence: A Ceiling on Effectiveness?

The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates. Behavioral Naltrexone Therapy (BNT) was developed to improve retention on oral naltrexone by integrating voucher incentives, Motivational and Cognitive Behavioral therapies, and a significant other for monitoring medication adherence. In a 6-month, randomized, controlled trial in heroin dependent patients, BNT (N ¼ 36) improved retention in treatment compared to a standard treatment control (Compliance Enhancement (CE); N ¼ 33) (log rank ¼ 4.28; p ¼ .04). Most patients retained beyond 3 months achieved abstinence from opioids, but retention at 6 months was only 22%on BNT and 9% on CE. A systematic review of related controlled trials revealed similar effect sizes in the small to medium range, and substantial dropout. There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone. Future research should consider combinations of behavioral methods with new long-acting injectable or implantable


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continued from page 14naltrexone formulations.

The American Journal of Drug and Alcohol Abuse, 32: 503–517, 2006 Edward V. Nunes, Jami L. Rothenberg,Maria A. Sullivan, Kenneth M. Carpenter, and Herbert D. Kleber, M.D

Cocaine Withdrawal Symptoms Predict Medication Response in Cocaine Users

The purpose of this study was to examine the influence of cocaine withdrawal symptoms on addiction severity and treatment outcomes in methadone stabilized cocaine users who participated in pharmacotherapy trials usinggamma-aminobutyric acid (GABA) medications. Subjects who fulfilled DSM-IV cocaine withdrawal criteria (n ¼ 45), compared to those who did not (n ¼ 40), showed a greater increase in cocaine free urines in response to pharmacotherapy with GABA medications. Altogether, our results and previous studies support the clinical utility of cocaine withdrawal symptoms in predicting treatment response to medications, such that low withdrawal severity may predict better treatment response to GABA medications, while high withdrawal severity may predict better response to adrenergic blockers. This hypothesis needs to be tested in prospective clinical trials.

The American Journal of Drug and Alcohol Abuse, 32: 617–627, 2006. Mehmet Sofuoglu, James Poling, Gerardo Gonzalez, Kishor Gonsai, and Thomas Kosten

Does cannabis use predict poor outcome for heroin dependent patients on maintenance treatment? Past findings and more evidence against

To determine whether cannabinoid-positive urine specimens in heroin dependent out-patients predict other drug use or impairments in psychosocial functioning, and whether such outcomes are better predicted by cannabis-use disorders than by cannabis use itself. Retrospective analyses of three clinical trials; each included a behavioral intervention (contingency management) for cocaine or heroin use during methadone maintenance. Trials lasted 25–29 weeks; follow-up evaluations occurred 3, 6 and

12 months post-treatment. For the present analyses, datawere pooled across trials where appropriate. The setting for this study was urban out-patient methadone clinic. The participants consisted of four hundred and eight polydrug abusers meeting methadone maintenance criteria .Participants were categorized as non-users, occasional users or frequent users of cannabis based on thrice-weekly qualitative urinalyses. Cannabis-use disorders were assessed with the Diagnostic Interview Schedule III-R. Outcome measures included proportion of cocaine- and opiate-positive urines and the Addiction Severity Index (at intake and follow-ups). Cannabis use was not associated with retention, use of cocaine or heroin, or any other outcome measure during or after treatment. Our analyses had a power of 0.95 to detect an r of 0.11 between cannabis use and heroin or cocaine use; the r we detected was less than 0.03 and non-significant. A previous finding, that cannabis use predicted lapse to heroin use in heroin abstinent patients, did not replicate in our sample. However, cannabis-use disorders were associated weakly with psychosocial problems at post-treatment follow-up. In conclusion, Cannabinoid-positive urines need not be a major focus of clinical attention during treatment for opiate dependence, unless patients report symptoms of cannabis-use disorders.

Society for the Study of Addiction to Alcohol and Other Drug s Addiction, 98, 269–279 D. H. Epstein & K. L. Preston

Drug dependence and psychological distress in Portuguese patients entering a substance abuse treatment center

In the current state of art of drug dependence treatment programs, psychopathological features seem to be associated with negative therapeutic outcome. Drug abuse and especially drug dependence are complex disorders that include cognitive, behavioral and physiologic signs and symptoms. The wide spectrum of symptoms thatcharacterize these disorders are responsible for clinical heterogeneity in terms of clinical presentation, severity, vulnerability, sequelae, and comorbidity which by itself accounts for great suffering and need for help in several areas. Assessment of both drug abuse and psychological distress constitutes a major challenge for professionals working with drug addicts. In the present descriptive study


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we tried to explore some key characteristics of individuals with a drug addiction when starting a treatment program. A total of 107 participants visiting a large metropolitan Portuguese addiction treatment center participated in this study, 90.7% were male, aged between 22 and 55 years (M = 34.84, SD = 6.44). The results indicate the existence of some relationships between severity of drug addiction and psychopathological symptoms.

International Journal of Clinical and Health Psychology 2007, Vol. 7, Nº 1, pp. 83-91. Paulo P.P. Machado2 and John M. Klein

Effects of Lower-Cost Incentives on Stimulant Abstinence in Methadone Maintenance Treatment

Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. The objective was to compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. The setting was six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. This study used three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. The main outcome measure were as follows; total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. The results, submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive

vs. usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was $120 per participant. In conclusion an abstinence incentive approach that paid $120 in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Arch Gen Psychiatry. 2006;63:201-208. Jessica M. Peirce, Nancy M. Petry, Maxine L. Stitzer, Jack Blaine, Scott Kellogg, Frank Satterfield; Marion Schwartz, Joe Krasnansky, Eileen Pencer, Lolita Silva-Vazquez, Kimberly C. Kirby, Charlotte Royer-Malvestuto, John M. Roll, Allan Cohen, Marc L. Copersino, Ken Kolodner, Rui Li,

Excessive Alcohol Consumption is associated with Reduced Quality of life among methadone patients

This study evaluated the impact of excessive alcohol consumption on the health-related quality of life of 192 patients receiving methadone maintenance treatment (MMT) for opioid dependence in England. Quality of life (QoL) was assessed using the Medical Outcomes Study: General Health Survey, Short Form (SF-12). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).Approximately one-third of the sample (57/192) were AUDIT-positive (score >/= 8) and 20 of the 135 AUDIT-negative patients reported a past history of alcohol problems. AUDIT-positive patients were less satisfied with their methadone dose than AUDIT-negative patients (P = 0.002), despite having a higher methadone dose. AUDIT-positive patients also reported significantly more physical and psychological health problems, and poorer QoL. The researchers concluded that excessive alcohol consumption may be associated with a distinctive pattern of QoL impairment in MMT patients. In addition to advising patients regarding their alcohol consumption, comprehensive care plans should seek to restore normal personal, family, and social role functioning through the provision of appropriate health and social care.

Addiction. 2007;102(2):257-263. Senbanjo R, Wolff K, Marshall J.


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Factors affecting detoxification readmission: Analysis of public sector data from three states.

The objective of this study was to understand the rate of detoxification readmissions and the factors associated with readmission within a public sector population. The study sample was drawn from an integrated database that includes Medicaid and state mental health and substance abuse agency data from three states (Delaware, Oklahoma, and Washington) for 1996–1998. Clients with at least one state agency sponsored detoxification event in 1996 or 1997 were included in the study. Twenty-seven percent of the sample was readmitted for detoxification within 1 year of their index detoxification. Clients who received two or more substance-abuse-related services within 30 daysof their index detoxification were less likely to be readmitted and had a longer time until their second detoxification admission. Detoxification readmission is common in the public sector. Engaging patients in treatment following detoxification may reduce readmission rates and time to readmission.

Journal of Substance Abuse Treatment 31 (2006) 439– 445 Tami L. Mark, Rita Vandivort-Warren, Leslie B. Montejano,

Methadone in pregnancy: treatment retention and neonatal outcomes.

The aim is to examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. The measurements used were, Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. The findings show that there were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who

were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. In conclusion continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented.

Lucy Burns, Richard P. Mattick, Kim Lim & Cate Wallace

Methadone: Is it Enough?

This paper looks at the applications of methadone in day-to-day clinical practice.

It reviews the evidence of effectiveness, including those areas in which the outcomes of methadone treatment are less satisfactory. Although the majority of patients respond well to methadone maintenance, about one in four tends not to respond well to treatment. An important question is how to achieve a better understanding of the reasons why patients respond or fail to respond to methadone treatment. The paper considers some ways in which methadone treatments could be strengthened.

Heroin Addict Relat Clin Probl 2006; 8(4): 53-64. Michael Gossop

Nonmedical use of prescription drugs among a longitudinal sample of dependent and problem drinkers

Increasing trends in the nonmedical use of prescription drugs (NMPD) have been documented, yet little is known about the demographic, severity, and social network influences related to NMPD among treated and untreated problem and dependent drinkers. To determine NMPD over four post-baseline interviews, the current study uses a 7-year longitudinal sample of 1598 dependent


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continued from page 17and problem drinkers, many also using illegal drugs, who were identified through a probability survey in the general population and consecutive intakes in public and private chemical dependency treatment programs in a California county. A panel model incorporating variables from the fourpost-baseline interviews was used, with baseline variables added for control. The use of illegal drugs (OR = 2.18, CI 1.28–3.70), including marijuana (OR = 2.66, CI 1.74–4.08), and the nonmedical use of prescription drugs prior to the baseline interview (OR = 2.53, CI 1.48–4.33) were related to NMPD over the study period. Larger heavy alcohol and drug using social networks were also related to NMPD (OR = 1.03, CI 1.01–1.05). When examining a sample of dependent and problem drinkers, many of the results obtained were similar to results in the literature predicting drug, and even alcohol, use more generally. In this sample, illegal drug use, and marijuana use were important predictors of NMPD.

Thus, the nonmedical use of prescription drugs may not be the first problem noticed by health and psychiatric providers.

Drug and Alcohol Dependence 86 (2007) 222–229 Helen Matzger, Constance Weisner

Nonreporting of cannabis use: Predictors and relationship to treatment outcome in methadone maintained patients

Underreporting of drug use is common and influenced by multiple factors. Cannabis (THC) use nonreporting and its relationship to heroin and cocaine use were investigated in 690 patients enrolled in 25- to 29-week clinical trials of contingency management plus methadone maintenance. Urine specimens and self-reports of drug use were collected 3 times/week. Potential predictors of THC use nonreporting were analyzed by multiple logistic regression; relationships between THC use nonreporting and % cocaine- and opiate-positive urines were analyzed by multiple regression. Compared to non-THC users (n=317), patients with THC-positive urines (n=373) were more likely to be male and have more years of THC use, but were not different on other characteristics. Nonreporting to user ratios were: THC 191/373 (51.2%); opiates 17/686 (2.5%); cocaine 21/681

(3.1%). Predictors of THC use nonreporting were low rate of THC-positive urines during treatment, fewer days of THC use in the last 30 before treatment, African-American race, and absence of antisocial personality disorder. Nonreporting of THC use was associated with significantly greater opiate and cocaine use. Contingency management decreased cocaine use in THC nonreporters to the level of reporters. Nonreporting of THC use is a significant predictor of greater cocaine and heroin use. This association can be eliminated with contingency management therapy.

Addict Behav. 2006 Aug 1 Ghitza UE, Epstein DH, Preston KL.

Oral delta-�-tetrahydrocannabinol suppresses cannabis withdrawal symptoms stitches

This study assessed whether oral administration of delta-9-tetrahydrocannbinol (THC) effectively suppressed cannabis withdrawal in an outpatient environment. The primary aims were to establish the pharmacological specificity of the withdrawal syndrome and to obtain information relevant to determining the potential use of THC to assist in the treatment of cannabis dependence. Eight adult, daily cannabis users who were not seeking treatment participated in a 40-day, within-subject ABACAD study. Participants administered daily doses of placebo, 30 mg (10 mg/tid), or 90 mg (30 mg/tid) oral THC during three, 5-day periods of abstinence from cannabis use separated by 7–9 periods of smoking cannabis as usual. Comparison of withdrawal symptoms across conditions indicated that (1) the lower dose of THC reduced withdrawal discomfort, and (2) the higher dose produced additional suppression in withdrawal symptoms such that symptom ratings did not differ from the smoking-as-usual conditions. Minimal adverse effects were associated with either active dose of THC. This demonstration of dose-responsivity replicates and extends prior findings of the pharmacological specificity of the cannabis withdrawal syndrome. The efficacy of these doses for suppressing cannabis withdrawal suggests oral THC might be used as an intervention to aid cannabis cessation attempts.

Drug and Alcohol Dependence 86 (2007) 22–29 Alan J.


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continued from page 18Budney, Ryan G. Vandrey b, John R. Hughes c, Brent A. Moored, Betsy Bahrenburg

Preliminary evidence of good treatment response in antisocial drug abusers

Antisocial personality disorder (APD) is a chronic debilitating condition strongly associated with the development and maintenance of severe drug and alcohol use disorder. The overlap of these problems is associated with high rates of personal and social suffering. Available literature consistently point to this as a population in need of effective clinical services. The present study reports preliminary data from a controlled clinical trial aimed at improving the treatment outcomes of antisocial drug abusers using an intensive behavioral approach relying upon a highly structured contingency management intervention. Drug abusers in methadone substitution therapy (n_40) were assessed for APD and other psychiatric and substance use problems. Patients were randomly assigned to an experimental (n_20) or control (n_20) condition following stratification on demographic and selected clinical variables (baseline drug use, evidence of other non-substance use psychiatric diagnoses). Treatment outcome data are presented for the first 17 weeks of participation in the study (4 weeks baseline and 13 weeks randomized treatment), including results of weekly urine drug testing and monthly self-reports of drug use and other psychosocial problems. Patients in both study conditions attained generally good outcomes. These early results suggest that antisocial drug abusers can respond positively to drug abuse treatments with a behavioral focus, but fail to support superior effectiveness for the more intensive intervention used in the experimental condition.

Drug and Alcohol Dependence 49 (1998) 249–260 Robert K. Brooner , Michael Kidorf, Van L. King, Kenneth Stoller

Screening for Substance Use Patterns among patients Referred for a Variety of Sleep Complaints

Virtually all psychiatric and substance use disorders are associated with sleep disruption. Studies indicate that psychiatric disorders are related closely to chronic

insomnia and that psychoactive substances have acute and chronic effects on sleep architecture. Several aspects of sleep are compromised in individuals taking these substances, ranging from difficulty initiating sleep to difficulty maintaining sleep and hypersomnia. Sleep disturbances are apparent in person taking psychoactive drugs or alcohol and have been found to persist long after withdrawing from these drugs. For some, sleep disturbance can be so severe as to reverse treatment success and precipitate relapse to addiction or dependence. There is increasing evidence that primary insomnia without a concurrent psychiatric disorder is a risk factor for later developing substance use disorders. Patients were asked to complete two brief screening tools, the Michigan Alcohol Screening Test and Drug Abuse Screening Test, to examine substance use patterns among patients referred for a variety of sleep complaints in a sleep disorders clinic. We found that patients who demonstrated a variety of sleep complaints were more likely to have alcohol and drug problems than those in the general populations.

American Journal of Drug and Alcohol Abuse 2006;32(1):111-20. Teplin D, Raz B, Daiter J, Varenbut M, Tyrrell M.

Self-medication Prevalent in Patients with Anxiety Disorders

Persons who have anxiety disorders commonly self-medicate with alcohol and other drugs, a recent survey confirmed. The results were published in the November 2006 issue of The Journal of Nervous and Mental Disease. Dr James Bolton and colleagues, from the University of Manitoba in Canada, administered a nationally representative survey of a modified version of the Composite International Diagnostic Interview in the United States; 5877 persons responded, and of the respondents, 1477 were identified as having an anxiety disorder. The study was administered from September 1990 to February 1992.The presence of any anxiety disorder was associated with a 21.9% prevalence of self-medication with drugs and alcohol. Persons with generalized anxiety disorder showed the highest self-medication rate (35.6%) and persons with bipolar I disorder showed the lowest rate (only 12.6% of respondents indicated self-medication). White persons


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were more likely to self-medicate than any other race (84.5%). Men were more likely to self-medicate than women (55.4% vs 44.6%).The researchers found that people who self-medicate were also more likely to be separated or divorced (18.7% vs 11.8%), were more likely to have had suicidal thoughts (44.1% vs 18.1%), and were more likely to have attempted suicide (23.7% vs 6.24%). In addition, 56.8% of persons who admitted to self-medicating also had major depression, compared with 30.7% who did not self-medicate.The authors noted that the findings of this study underscore the need for clinical assessment for comorbidity and suicidality in patients with anxiety disorders who use drugs or alcohol to reduce their anxiety symptoms.

Psychiatric Times, January 2007, Vol. XXIV, No. 1

Summary of findings from the evaluation of a pilot medically supervised safer injecting facility

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-yearscientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV riskbehaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use.

Evan Wood, Mark W. Tyndall, Julio S. Montaner, Thomas Kerr

Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment

The growing tendency among opioid addicts to misuse multiple other drugs should lead clinicians and researchers to search for new pharmacological strategies in order to prevent life-threatening complications and minimize withdrawal symptoms during polydrug detoxification. A non-randomised, open-label in-patient detoxification study was used to compare the short-time efficacy of a standardised regimen comprising 6 days Buprenorphine and 10 days Valproate (BPN/VPA) (n = 12) to a control group (n = 50) who took a 10-day traditional Clonidine/ Carbamazepine (CLN/CBZ) regimen. Sixty-two dependent subjects admitted to a detoxification unit were included, all dependent on at least opioids and benzodiazepines. Other dependencies were not excluded. In the BPN/VPA group, 8 out of 12 patients (67%) completed treatment compared with 25 of 50 patients (50%) in the CLN/CBZ group; this difference between the groups was nonsignificant (p = 0.15). Withdrawal symptoms were reduced in both groups, but only the BPN/VPA group achieved a reduction in withdrawal symptoms from day one. The difference between the two groups was significantly in favour of the BPN/VPA group for days 2 (p < 0.001), 3 (p < 0.05), 4 (p < 0.001), 5 (p < 0.01), 7 (p < 0.01) and 8 (p < 0.05). The BPN/VPA combination did not affect blood pressure, pulse or liver function, and the total burden of side-effects was experienced as modest. There appeared to be no pharmacological interactions of clinical concern, based on measurement of Buprenorphine and Valproate serum levels. Both the patients and the staff were satisfied with the standardised treatment combination. Overall, the combination of Buprenorphine and Valproate seems to be a safe and promising method for treating multiple drug withdrawal symptoms. The results of this study suggest that the BPN/VPA combination is potentially a better detoxification treatment for polydrug withdrawal than the traditional treatment with Clonidine and Carbamazepine. However, a randomised, double-blind study with a larger sample size to confirm our results is recommended.

BMC Psychiatry 2006, 6:54 Øistein Kristensen, Terje Lølandsmo1, Åse Isaksen1, John-Kåre Vederhus and Thomas Clausen


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CALL FOR ABSTRACTS

Canadian Society of Addiction Medicine 19th Annual Scientific MeetingOttawa, Ontario, Canada – October 11-13, 2007

CONFERENCE THEME: Multiple Disciplines, Shared Cause: Connecting Professionals in Addiction MedicineCSAM looks forward to welcoming speakers and delegates who work in the field of addiction medicine, including: physicians,researchers, nurses, psychologists, counsellors, pharmacists, educators, policy makers, social workers, and students.

Abstract Presentation FormatsAbstracts may be presented in any of the following three formats:

1. Workshop – 60 minute workshop including small group discussion and skill building2. Oral Presentation – 20 minute presentation and 10 minutes of questions/discussion3. Poster Presentation

CSAM welcomes the submission of panel presentations in both the workshop and oral presentation formats.

Abstract RequirementsAll abstracts must be submitted in either hard copy or electronic copy on or before Friday June 1, 2007. The abstract body mustnot exceed 350 words (including tables and references).

GuidelinesCSAM welcomes abstracts in the following categories: Original Research: Quantitative or qualitative studies. The abstract should include a brief statement of the objective,

rationale, methodology, results and conclusions of the study. Program Descriptions: Description of the planning, implementation and/or evaluation of a program. No data are required. Literature Review: Summary and analysis of the current literature on a specific topic.

Abstracts are welcome from both CSAM members and non-members. There is no limit to the number of abstracts that anindividual may submit.

Student AwardOne student award of $500 plus complimentary conference registration is available. If you would like to apply, please submit aletter of support with your abstract. Competition is open to undergraduate and post graduate medical trainees as well as graduatestudents in related disciplines.

Submission InstructionsPlease submit your abstract and completed abstract submission form:

a. By email to [email protected]

OR

b. By fax or mail to:CSAM Head Office

375 West 5th Avenue, Suite 201Vancouver, BC, Canada V5Y 1J6

Fax: 604-874-4378 Attention: Alexis Martis

Abstracts and abstract submission forms must be submitted by Friday, June 1, 2007.

Notice of abstract acceptance will be sent to authors at least two months prior to the conference. All abstracts will be reviewed forscientific merit using predetermined criteria and accepted abstracts will be printed in the final program that will be distributed on-site at the conference and made available electronically on CSAM’s website. Abstracts should be submitted only if an authorintends to attend the meeting and present the abstract if accepted. Those presenting abstracts will be responsible for their owntravel and meeting expenses.

Conference InquiriesPhone: 604-484-3244Fax: 640-874-4378E-mail: [email protected]

Abstract Deadline is Friday June 1, 2007


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Abstract Submission Form19th Annual Scientific Conference

October 11-13, 2007, Ottawa

Abstract Title ________________________________________________________________________________________

Presenting Author:

Name __________________________________________________________________________________________ Last | Nom de famille First | Prénom Initial | Initiale

Department _________________________________________ Institution _________________________________________

Address ______________________________________________________________________________________

City__________________________ Province _______________ Postal Code _________________

Telephone ____________________ Fax _____________________ Email | Courriel ______________________________

Other Authors:

Name Institution City/Province

1.

2.

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6.

Which format would you prefer for presentation of your abstract? (please check one)

Workshop – 60 minutes Oral Presentation – 30 minutes Poster Presentation

I understand that an accepted abstract will appear in the final program and abstract book, which will be made available in printedform to the conference delegates, and electronically on the CSAM website.

I understand that CSAM may use my name and abstract title in promotional material distributed in relation to the meeting.

I understand that I will receive no remuneration from CSAM unless otherwise specified in writing by the Society.

I understand that abstract authors are expected to present their abstract, if it is selected for presentation, at the CSAM AnnualMeeting, October 11-13, 2007 in Ottawa, Ontario. I understand that abstract authors are required to register for the meeting.

Signature : Date:

Please send a completed abstract submission form along with your abstract by Friday, June 1, 2007, to:Canadian Society of Addiction Medicine

375 West 5th Avenue, Suite 201Vancouver, BC, Canada V5Y 1J6

Fax: 604-874-4378 Attention: Alexis MartisEmail: [email protected]


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Potential Topics

CSAM welcomes abstracts on a broad range of topics, including:

Multidisciplinary Addiction Medicine Shared Care Tx in Correctional Settings and with Correctional

Pops Tx in Primary Care Screening and Brief Interventions for at-risk drug

and alcohol use in Primary Care Tx for dual diagnosed clients -

screening/assessment of DD Integration of services for alcohol and drug

abusing clients Patient referral across services Social Co-morbidity Legal Co-morbidity Low Threshold Tx and Outreach for IDU

General Concepts: Substance Dependence and Aboriginal

Community Harm Reduction or Abstinence Definitions of Tolerance/Dependency/Addiction Differences/similarities between addictions Clinical aspects of dependency and addiction Assessments – history – state of mind –

potentials

Basic Science: Genetic and environmental factors Neurobiology – transmitters, receptors, etc. Effects of drugs on sleep.

Behavioural Addictions Gambling

Drug “Addictions” Alcohol dependency Opioid dependency Benzodiazepine dependency Stimulant use in MMT patients

Physical Comorbidity Pain Neonatal Abstinence Syndromes

Mental Comorbidity Mental Comorbidity in MMT patients

Social Comorbidity Social aspects of dependency and addiction

Legal Comorbidity Legal aspects of dependency and addiction Provincial Corrections Drug Policy

Therapy What to use, and when Psychotherapy principles, practice Methadone Methadone Induction Techniques Methadone for Palliative Care Methadone for Pain Management Pain management in Methadone patients Insomnia in the presence of substance

dependence Interpretation of Toxicology testing Management of Hep C in substance abusers Management of HIV in substance abusers Anesthesia Assisted Rapid Opiate Detoxification Detoxification strategies

Canadian Society of Addiction MedicineLa Société Médicale Canadienne sur l’Addiction

BoArd oF dirECTorS

Continuing Medical Education OpportunitiesDates for Future CSAM Annual Scientific conferences

2007 – october 11-13 ottawa, oN2008 – Vancouver, BC2009 – Calgary (as joint meeting with iSAM)

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